Decision Report 201708119

Summary

Mr C complained about the treatment he had received at the Accident and Emergency Department at the Queen Elizabeth University Hospital. He had experienced leg pain for a number of months and was shortly going to go for planned surgery at a private hospital. A few days before the private surgery was due, his condition deteriorated and his leg felt numb. He was referred to the Accident and Emergency Department by his GP for a review and, after a few checks, was told to return home. Mr C's condition continued to deteriorate and he contacted the private hospital for advice and was told to return to Accident and Emergency. Following a scan it was diagnosed that Mr C had cauda equina syndrome (a spinal cord nerve disorder which can cause bladder and bowel disturbance as well as altered sensation in the saddle area). Mr C felt that there had been a failure in his treatment at the initial presentation to Accident and Emergency and that the diagnosis of cauda equina syndrome could have been made earlier.

We took independent advice from an emergency medicine adviser and an orthopaedic adviser (a specialist concerned with the musculoskeletal system). We found that, although the GP referral letter mentioned that Mr C had altered sensation in the saddle area (which is a red flag sign for cauda equina syndrome), observations in hospital had recorded that there was no numbness present around the anal area. We could not account for the conflict in information between the GP and the hospital. We did, however, note that a comprehensive examination and medical history had been taken in the Accident and Emergency Department and that Mr C had been advised to return to the Accident and Emergency Department or to contact the private hospital if his symptoms deteriorated. On balance we considered that Mr C had received a thorough assessment on initial attendance at the Accident and Emergency Department and that appropriate advice was given to seek further medical review should his condition deteriorate. We did not uphold the complaint.